Pulmonary Fibrosis

Fibrosis and pulmonary emphysema

07/07/2008

Question:

I have nodule that is 10mm with parenchymal cystic changes in the right upper lobes consisent with pulmonary emphysema There is dependent atelectasis posteriorly in the lung bases. Plus an area of Fibrosis in the right lung apex. And a small pulmonary nodule in the left upper lube that is 3mm. I have a second opinion in Aug of 2008.

Answer:

From your question, it appears that there are at least 4 problems that may be inter-related. First, there are 2 pulmonary nodules. In evaluating these, the most important first step is to see if there are old x-rays from 2 years or longer in the past. If nodules were present and the same size for at least 2 years, then they can generally be considered benign.

Second, there is emphysema which is usually related to smoking.

Third, there is atelectasis, which means an area where the lung is partially collapsed; atelectasis related to a pulmonary nodule is particularly worrisome for possible cancer.

Fourth, there is fibrosis. This can result from many conditions but focal areas of fibrosis in a single location in the lung is most commonly a scar.

Given this constellation of findings, it would be important to ask several questions when you have a second opinion.

First, ask if the x-rays suggest previous tuberculosis and as whether you should be tested for TB.

Second, ask whether there are old x-rays that indicate whether or not the findings are new (more worrisome) or older than 2 years (less worrisome).

Third, ask whether the findings are possibly due to lung cancer and if so, what the physician recommends for further evaluation and testing.

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